I. Personal
First Name*
MI
Last Name*
Address*
City*
State*
Alabama
ALASKA
ARIZONA
ARKANSAS
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
DISTRICT OF COLUMBIA
FLORIDA
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANA
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTA
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTA
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEE
TEXAS
UTAH
VERMONT
VIRGINIA
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
OTHER
Zip Code*
Date of Birth* (ie: mm/dd/yyyy)
Home Phone* (ie: 111-111-1111)
Cell Phone
Email Address
Father's Name
Mother's Name
Individual You Live with
Relationship to Individual
Graduation Year
Transfer Student
No
Yes
Curriculum/Major
undecided
ARCHITECHTURAL TECH
AUTOBODY REPAIR
AUTOMOTIVE TECH
BIOLOGY CITY
BIOLOGY NORTH
BIOLOGY SOUTH
BLDG MGMT & MAINTENANCE
BUSINESS ADMIN CITY
BUSINESS ADMIN NORTH
BUSINESS ADMIN SOUTH
CHEMICAL TECH CITY
CHEMICAL TECH NORTH
CHEMICAL TECH SOUTH
CIS CITY
CIS NORTH
CIS SOUTH
CIVIL ENG/CONSTUCTION TECH
COMPUTER REPAIR TECH
CRIMINAL JUSTICE CITY
CRIMINAL JUSTICE NORTH
DENTAL HYGIENE
DENTAL LAB TECH
DIETETIC TECH
DRAFTING TECH
ELECTRICAL ENG TECH
EMT CITY
EMT NORTH
EMT SOUTH
ENGINEERING SCIENCE
ENGLISH CITY
ENGLISH NORTH
ENGLISH SOUTH
FIRE PROTECTION TECH
FOOD SVCS/RESTAURANT MGMT
HEALTH INFO TECH
HOTEL TECH & CULINARY ARTS
HUMANITIES CITY
HUMANITIES NORTH
HUMANITIES SOUTH
MACHINE TOOL TECH
MANUFACTURING TECH
MATH/COMPUTER SCIENCE CITY
MATH/COMPUTER SCIENCE NORTH
MATH/COMPUTER SCIENCE SOUTH
MECHANICAL ENG TECH
MLT/MA
NURSING
OCCUPATIONAL THERAPY
OFFICE TECH CITY
OFFICE TECH NORTH
OFFICE TECH SOUTH
OPHTHALMIC DISPENSING
PARALEGAL
PHYSICS CITY
PHYSICS NORTH
PHYSICS SOUTH
RADIATION TECH
RESPIRATORY CARE
SOCIAL SCIENCE CITY
SOCIAL SCIENCE NORTH
SOCIAL SCIENCE SOUTH
TELECOM TECH
VISUAL COMM TECH
Enrollment Date
Fall
Spring
II. Athletics
High School
Coach's Name
Coach's Phone (ie: 111-111-1111)
Offensive Position(s)
Defensive Position(s)
Preferred College Position (list one)
Specialties
Height
Weight
Jersey Number
Speed 40 yard
Athletic Honors